Provider Demographics
NPI:1588711774
Name:DORAN, JENNIFER SUE (RN, PHN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:DORAN
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 LUPINE RD
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1223
Mailing Address - Country:US
Mailing Address - Phone:510-799-3697
Mailing Address - Fax:510-799-3697
Practice Address - Street 1:355 TUOLUMNE ST
Practice Address - Street 2:MS 20-210
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5700
Practice Address - Country:US
Practice Address - Phone:707-553-5402
Practice Address - Fax:707-553-5649
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202180163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse